agenda item #: 3s2 palm beach county board of …
TRANSCRIPT
Agenda Item 3S2
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date October 6 2020 [X] Consent [ ] Regular [ ] Workshop [ ] Public Hearing
Department Fire-Rescue
I EXECUTIVE BRIEF
Motion and Title Staff recommends motion to
A) receive and file a Public Emergency Medical Transportation (PEMT) Letter of Agreement (LOA) with the State of Florida Agency for Health Care Administration (AHCA) relating to intergovernmental transfer to the State for the supplemental payment program for Medicaid managed care patients for State FY 2019-2020 and
B) approve agreements with seven Medicaid Managed Care Organizations (MCO) listed below for the period October 1 2019 through June 30 2024 to allow for direct supplemental payments from the MCO to the County for their covered patients who are transported to a hospital
1 Florida Community Care LLC 2 Miami Childrens Health Plan LLC 3 WellCare of Florida Inc dbaStaywell 4 Sunshine State Health Plan Inc 5 Simply Healthcare Plans Inc dba Clear Health Alliance 6 Florida True Health Inc dba Prestige Health Choice 7 Humana Medical Plan Inc
Summary Last fall AHCA established the Florida Medicaid Managed Care Supplemental Payment Program (MCO program) which will allow qualifying government owned ambulance providers to receive supplemental payments for emergency transports of Medicaid managed care patients In order to guarantee Federal share funding intergovernmental transfers (IGT) from PEMT providers are required to cover the States share of the MCO program On September 10 2019 the Board delegated authority (R2019-1462) to execute LOAs with the State of Florida relating to IGTs for this program One LOA is now being received and filed in accordance with PPM CW-0-051 Pursuant to the MCO agreements required by the program the Medicaid MCOs will make payments to the County for their covered patients who are transported to a hospital For the States FY 2019-2020 the Countys IGT was 68971733 and the County is expected to receive $1793265 in supplemental payments from MCOs for an estimated net revenue of $1103548 For the States FY 2020-2021 the Countys IGT and estimated net revenue are expected to stay the same We have scanned signatures on the LOAs for Simply Healthcare Plans Inc dba Clear Health Alliance and Florida True Health Inc dba Prestige Health Choice and are expected to receive the original signatures Countywide (SB)
Background and Justification Palm Beach County Fire Rescue transports over 70000 patients annually t0 local hospital emergency rooms of which approximately 10 of these transports are for Medicaid patients In 2016 the State of Florida authorized the creation of a Public Emergency Medical Transportation (PEMT) Certified Public Expenditure (CPE) program to provide supplemental payments to public emergency medical transportation providers for Medicaid fee for service patients transported to hospitals The PEMT CPE program helps to close the gap between actual costs incurred and revenue received for each emergency medical transport Over the past four years Fire Rescue has received over $76 million from the PEMT CPE program In 2019 Floridas Legislature authorized the expansion of the PEMT program to include Medicaid managed care patients In order to leverage the approximately 60 Federal share qualifying government owned ambulance providers are to provide the approximately 40 States share through GTs The revenue from this program will be received through the various Medicaid managed care providers for their covered patients who are transported to a hospital The agreements with MCOs cover multiple years however the LOA with AHCA is required each year
Attachments 1 PEMT GT LOA with AHCA for State FY 2019-2020 2 LOAs with MCOs (7)
Recommended by
II FISCAL IMPACT ANALYSIS
A Five Year Summary of Fiscal Impact
Fiscal Years Capital Expenditures Operating Costs External Revenues Program Income County) In-Kind Match County)
2020 2021 2022
689718 1793265
2023 2024
NET FISCAL IMPACT 1103547
ADDITIONAL FTE POSITIONS Cumulative) 0
Is Item Included in Current Budget Yes X No Does this item include the use of federal funds Yes No X
Budget Account No Budget Account No
Fund Fund
1300 1300
Dept 440 Unit 4210 Rev Source Dept 440 Unit 4209 Obj Code
4261 3401
B Recommended Sources of FundsSummary of Fiscal Impact
The County provided $689718 from MSTU ad valorem (non-Federal) funds for the States share for this Medicaid managed care supplemental payment program for FY 2019-2020 through an IGT in order to receive $1793265 for a net revenue of $1103547 This additional revenue will be used to offset actual expenditures for emergency transports
C Departmental Fiscal Review Cfcy ~~
Ill REVIEW COMMENTS
A OFMB Fiscal andor Contract Development and Control Comments
B Legal Sufficiency
amp i3 JN--J r n I~ Q Assistant County Attorney
C Other Department Review
Department Director
REVISED 903 ADM FORM 01 THIS SUMMARY IS NOT TO BE USED AS A BASIS FOR PAYMENT)
CUsersdmacdonaAppDataLocalMicrosoftWindowslNetCacheContentOutlookEYW0UWU10-06-2020 RF AHCA LOA and MCO LOAs FINALdoc
Public Emergenc-y Medical Transportation Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 3Qlli
day of o~~mber 20191 by and betw~en Palm Beach County on behalf of Palm Be~ch County Fire Rescue and the State of Florida Agency for Health Cate Administration (the 1Agency) 1
for good and valuable consideration the receipt and sufficiency of which is acknowledged
DEFINITIONS
Intergovernmental Transfers (IGTs) means transfers offunds from a non-Medicaid governmental entity (eg counties1 hospital taxing districtsj providers operated by state or local government) to the Medicaid agency IGTs must be compliant with 42 CFR Part 433 Subpart 8
11Medicaid mean~ the medical assistance program a)thorized by Title XIX of the Social Security Act 42 usc~ sectsect 1396 et seq and regulations thereuhderl as administered in Florida by the Agency
Public Emergency Medical Transportation (PEMT) pursu~nt to the General Appropriation Act Laws of Florida 2019-115 is the program that provides supplemental payments for eligjble Public Emergency Medical Transportation (PEMT) entities that meet specified requirements and pmiddotrovide emergency medical transpmiddotortation services to Medicaid beneficiaries
A GENERAL PROVISIONS
1 Per Senate Bill 2500 the General Appropriations Act of State Fiscal Year 2019-2020 p~s$ed by the 2019 Florida Legislature Palm Beach County and the Agency agree that Palm Beach county will remit IGT funds to the Agency in ~n amount not to exceed the total of $70734128 Palm Beach County and the Agency have agreed that these IGT funds will only be used for the PEMT program
2 Palm Beach County will return the signed LOA to the Agency
3 Palni Beach County will pay IGT funds to the Agency in an amount not to exceed the total of ~70734128 Palm Beach County will transfer payments to the Agency in the following manner
a Per Florida Statute 409908i annual payments forthe months of July 2019 thru June 2020 are due to the Agency no later than October 31 2019 unless an alternative plan is specifically approved by the agency
b The Agency will bill Palm Beach County when payment is due
4 Palm Beach County and the Agency agree that the Agency will maintain necessary records and supporting documentation applicable to health servioes covered by this LOA in accordance with public records laws and establishetl retention schedules
a AUDITS AND RECORDS
i Palm Beach County agrees to maintain books records and documents (including
Palm Beach Co~nty_Palm Beach County Fire Rescue_PEMT LOA_SFY 2019-20
electronic storage medi~) pertinent to performance under this LOA in accordance with generally accepted accounting procedures and practices which sufficiently ~ncf properly reflect all revenues and expenditqres of funds provided
ii Palm Beach County agrees to assure that these records shall be subject at all reasonable time$ to inspection review or audit by state personnel and other personnel dlJly authorized by the Agency as well as by feder~I p~rsonnel
iii Pafm Beach County ~grees to comply with public record laws as outlined in section 1190701 Florjda Statutes
b RETENTION OF RECORDS
i The Palm Beach County agrees to retafn all financial records supporting dOCllrnents statistical records amiddotnd any other documents (including electronic storage media) pertinent to performance under this LOA for a period of six (6) years after termination of this LOA or if an audit has been initiated and audit findings have not been resolved at the end of six (6) years the records shall be retained until resolution of the audit fincUngs
ii Persons duly authorized by the Agency an_d federal auditors shall have full access to and the right to examine any of said records and documents
m The rights of access in this section must not be limited to the required retention period but shall last as long as the records are retained
c MONITORING
i Palm Beach County agrees to permit persons duly authorized by the Agency to im~pect any records papers1 and documents of the Palm Beach County which are relevant to this LOA
d ASSIGNMENT AND SUBCONTRACTS
L The Palm Beach County agrees to neither assign the responsibility of this LOA to another party nor subcontract for any of the work contemplated under this LOA without prior written approval of the Agency No such approval by the Agency of any assignment or subcontract shall be deemed in any event or in any manner to provide for the incurrence of any obligation of the Agency in addition to the total dollar amount agreed upon in this LOA All such assignments or subcontracts shall be subject to the conditions of this LOA and to any conditions of approval that the Agency shall deem neeessary
5 This LOA may only be amended upon written agreement signed by both parties The Palm Beach County and the Agency agree that cllY modific~tions to this LOA shall be in the same form namely the exchange of signed copies of a revised LOA
6 Palm Beach County confirms that there are no pre-arranged agreements (contractual or otherwise) between the respective counties taxing districts andor the providers to reshydirect any portion of these aforementioned supplemental payments in order to satisfy nonshyMedicaid non-uninsured and non-underinsured activities
Palm Beach County_Palm Beach County Fire Rescue_PEMT LOA_SFY 2019-20
7 Palm Beach County agrees the following provision shall be included In any agreements between Palm Beach County and focal providers where IGT funrHng is provided pursu~nl to this LOA Funding provld~d In this agreement shall be prlotitlzed so 1hat designated IGT funding_ shall first be used to fund the Medicaid program anci used seconclarlly for
middot other purposes
8 This LOA covers thEJ period of July 1 2019 through June 30 2020 and shall be terminated June 30 2020~
9 This LOA may be executed In mu1tlple counterparts each of which shall constitute ~n orlglnal and each of which shall be fully binding on a11y party ~lgnlng a1 least one colnlerpart
Minimum FeeScheduleMOO IGTs $70734128middot middotTotarFuntlln 28
IN WITNESS WHEREOF the patties have caused this page Letter of Agreement to be executed by their undersigned offlclals as duly authorized
Fire Rescue lstralor through TITLE erdenla G_e er Cpunly Ad1nlnlslrelot
DATE Decenibetmiddot 30 2019
APPROVED AS TO TlRMS AND CQNJr TIONS
Palm Beach County_Palm Beach County Fire Resoue_PEMT LOA_SFY 2019-20
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida Community Care LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Eric Tatum
Title Palm Beach County Fire Rescue Title Director of Provider Services Finance Director
Phone 561-616-7021 Phone786-778-6825
Email mmartz(pbcgovorg Email etatumfcchealthplancom
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
08272020
Nestor Plana CEO liltmllsiBil JiVITHO RIZED INDIVIDUAL
amp~ GNATURE OF A ORIZED INDIVIDUAL
5DF56FDF363949E
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORtND LE~ SUFFICIENCY
By LAl G - 1vv--Palm BeacCounty Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
II FISCAL IMPACT ANALYSIS
A Five Year Summary of Fiscal Impact
Fiscal Years Capital Expenditures Operating Costs External Revenues Program Income County) In-Kind Match County)
2020 2021 2022
689718 1793265
2023 2024
NET FISCAL IMPACT 1103547
ADDITIONAL FTE POSITIONS Cumulative) 0
Is Item Included in Current Budget Yes X No Does this item include the use of federal funds Yes No X
Budget Account No Budget Account No
Fund Fund
1300 1300
Dept 440 Unit 4210 Rev Source Dept 440 Unit 4209 Obj Code
4261 3401
B Recommended Sources of FundsSummary of Fiscal Impact
The County provided $689718 from MSTU ad valorem (non-Federal) funds for the States share for this Medicaid managed care supplemental payment program for FY 2019-2020 through an IGT in order to receive $1793265 for a net revenue of $1103547 This additional revenue will be used to offset actual expenditures for emergency transports
C Departmental Fiscal Review Cfcy ~~
Ill REVIEW COMMENTS
A OFMB Fiscal andor Contract Development and Control Comments
B Legal Sufficiency
amp i3 JN--J r n I~ Q Assistant County Attorney
C Other Department Review
Department Director
REVISED 903 ADM FORM 01 THIS SUMMARY IS NOT TO BE USED AS A BASIS FOR PAYMENT)
CUsersdmacdonaAppDataLocalMicrosoftWindowslNetCacheContentOutlookEYW0UWU10-06-2020 RF AHCA LOA and MCO LOAs FINALdoc
Public Emergenc-y Medical Transportation Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 3Qlli
day of o~~mber 20191 by and betw~en Palm Beach County on behalf of Palm Be~ch County Fire Rescue and the State of Florida Agency for Health Cate Administration (the 1Agency) 1
for good and valuable consideration the receipt and sufficiency of which is acknowledged
DEFINITIONS
Intergovernmental Transfers (IGTs) means transfers offunds from a non-Medicaid governmental entity (eg counties1 hospital taxing districtsj providers operated by state or local government) to the Medicaid agency IGTs must be compliant with 42 CFR Part 433 Subpart 8
11Medicaid mean~ the medical assistance program a)thorized by Title XIX of the Social Security Act 42 usc~ sectsect 1396 et seq and regulations thereuhderl as administered in Florida by the Agency
Public Emergency Medical Transportation (PEMT) pursu~nt to the General Appropriation Act Laws of Florida 2019-115 is the program that provides supplemental payments for eligjble Public Emergency Medical Transportation (PEMT) entities that meet specified requirements and pmiddotrovide emergency medical transpmiddotortation services to Medicaid beneficiaries
A GENERAL PROVISIONS
1 Per Senate Bill 2500 the General Appropriations Act of State Fiscal Year 2019-2020 p~s$ed by the 2019 Florida Legislature Palm Beach County and the Agency agree that Palm Beach county will remit IGT funds to the Agency in ~n amount not to exceed the total of $70734128 Palm Beach County and the Agency have agreed that these IGT funds will only be used for the PEMT program
2 Palm Beach County will return the signed LOA to the Agency
3 Palni Beach County will pay IGT funds to the Agency in an amount not to exceed the total of ~70734128 Palm Beach County will transfer payments to the Agency in the following manner
a Per Florida Statute 409908i annual payments forthe months of July 2019 thru June 2020 are due to the Agency no later than October 31 2019 unless an alternative plan is specifically approved by the agency
b The Agency will bill Palm Beach County when payment is due
4 Palm Beach County and the Agency agree that the Agency will maintain necessary records and supporting documentation applicable to health servioes covered by this LOA in accordance with public records laws and establishetl retention schedules
a AUDITS AND RECORDS
i Palm Beach County agrees to maintain books records and documents (including
Palm Beach Co~nty_Palm Beach County Fire Rescue_PEMT LOA_SFY 2019-20
electronic storage medi~) pertinent to performance under this LOA in accordance with generally accepted accounting procedures and practices which sufficiently ~ncf properly reflect all revenues and expenditqres of funds provided
ii Palm Beach County agrees to assure that these records shall be subject at all reasonable time$ to inspection review or audit by state personnel and other personnel dlJly authorized by the Agency as well as by feder~I p~rsonnel
iii Pafm Beach County ~grees to comply with public record laws as outlined in section 1190701 Florjda Statutes
b RETENTION OF RECORDS
i The Palm Beach County agrees to retafn all financial records supporting dOCllrnents statistical records amiddotnd any other documents (including electronic storage media) pertinent to performance under this LOA for a period of six (6) years after termination of this LOA or if an audit has been initiated and audit findings have not been resolved at the end of six (6) years the records shall be retained until resolution of the audit fincUngs
ii Persons duly authorized by the Agency an_d federal auditors shall have full access to and the right to examine any of said records and documents
m The rights of access in this section must not be limited to the required retention period but shall last as long as the records are retained
c MONITORING
i Palm Beach County agrees to permit persons duly authorized by the Agency to im~pect any records papers1 and documents of the Palm Beach County which are relevant to this LOA
d ASSIGNMENT AND SUBCONTRACTS
L The Palm Beach County agrees to neither assign the responsibility of this LOA to another party nor subcontract for any of the work contemplated under this LOA without prior written approval of the Agency No such approval by the Agency of any assignment or subcontract shall be deemed in any event or in any manner to provide for the incurrence of any obligation of the Agency in addition to the total dollar amount agreed upon in this LOA All such assignments or subcontracts shall be subject to the conditions of this LOA and to any conditions of approval that the Agency shall deem neeessary
5 This LOA may only be amended upon written agreement signed by both parties The Palm Beach County and the Agency agree that cllY modific~tions to this LOA shall be in the same form namely the exchange of signed copies of a revised LOA
6 Palm Beach County confirms that there are no pre-arranged agreements (contractual or otherwise) between the respective counties taxing districts andor the providers to reshydirect any portion of these aforementioned supplemental payments in order to satisfy nonshyMedicaid non-uninsured and non-underinsured activities
Palm Beach County_Palm Beach County Fire Rescue_PEMT LOA_SFY 2019-20
7 Palm Beach County agrees the following provision shall be included In any agreements between Palm Beach County and focal providers where IGT funrHng is provided pursu~nl to this LOA Funding provld~d In this agreement shall be prlotitlzed so 1hat designated IGT funding_ shall first be used to fund the Medicaid program anci used seconclarlly for
middot other purposes
8 This LOA covers thEJ period of July 1 2019 through June 30 2020 and shall be terminated June 30 2020~
9 This LOA may be executed In mu1tlple counterparts each of which shall constitute ~n orlglnal and each of which shall be fully binding on a11y party ~lgnlng a1 least one colnlerpart
Minimum FeeScheduleMOO IGTs $70734128middot middotTotarFuntlln 28
IN WITNESS WHEREOF the patties have caused this page Letter of Agreement to be executed by their undersigned offlclals as duly authorized
Fire Rescue lstralor through TITLE erdenla G_e er Cpunly Ad1nlnlslrelot
DATE Decenibetmiddot 30 2019
APPROVED AS TO TlRMS AND CQNJr TIONS
Palm Beach County_Palm Beach County Fire Resoue_PEMT LOA_SFY 2019-20
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida Community Care LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Eric Tatum
Title Palm Beach County Fire Rescue Title Director of Provider Services Finance Director
Phone 561-616-7021 Phone786-778-6825
Email mmartz(pbcgovorg Email etatumfcchealthplancom
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
08272020
Nestor Plana CEO liltmllsiBil JiVITHO RIZED INDIVIDUAL
amp~ GNATURE OF A ORIZED INDIVIDUAL
5DF56FDF363949E
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORtND LE~ SUFFICIENCY
By LAl G - 1vv--Palm BeacCounty Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Public Emergenc-y Medical Transportation Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 3Qlli
day of o~~mber 20191 by and betw~en Palm Beach County on behalf of Palm Be~ch County Fire Rescue and the State of Florida Agency for Health Cate Administration (the 1Agency) 1
for good and valuable consideration the receipt and sufficiency of which is acknowledged
DEFINITIONS
Intergovernmental Transfers (IGTs) means transfers offunds from a non-Medicaid governmental entity (eg counties1 hospital taxing districtsj providers operated by state or local government) to the Medicaid agency IGTs must be compliant with 42 CFR Part 433 Subpart 8
11Medicaid mean~ the medical assistance program a)thorized by Title XIX of the Social Security Act 42 usc~ sectsect 1396 et seq and regulations thereuhderl as administered in Florida by the Agency
Public Emergency Medical Transportation (PEMT) pursu~nt to the General Appropriation Act Laws of Florida 2019-115 is the program that provides supplemental payments for eligjble Public Emergency Medical Transportation (PEMT) entities that meet specified requirements and pmiddotrovide emergency medical transpmiddotortation services to Medicaid beneficiaries
A GENERAL PROVISIONS
1 Per Senate Bill 2500 the General Appropriations Act of State Fiscal Year 2019-2020 p~s$ed by the 2019 Florida Legislature Palm Beach County and the Agency agree that Palm Beach county will remit IGT funds to the Agency in ~n amount not to exceed the total of $70734128 Palm Beach County and the Agency have agreed that these IGT funds will only be used for the PEMT program
2 Palm Beach County will return the signed LOA to the Agency
3 Palni Beach County will pay IGT funds to the Agency in an amount not to exceed the total of ~70734128 Palm Beach County will transfer payments to the Agency in the following manner
a Per Florida Statute 409908i annual payments forthe months of July 2019 thru June 2020 are due to the Agency no later than October 31 2019 unless an alternative plan is specifically approved by the agency
b The Agency will bill Palm Beach County when payment is due
4 Palm Beach County and the Agency agree that the Agency will maintain necessary records and supporting documentation applicable to health servioes covered by this LOA in accordance with public records laws and establishetl retention schedules
a AUDITS AND RECORDS
i Palm Beach County agrees to maintain books records and documents (including
Palm Beach Co~nty_Palm Beach County Fire Rescue_PEMT LOA_SFY 2019-20
electronic storage medi~) pertinent to performance under this LOA in accordance with generally accepted accounting procedures and practices which sufficiently ~ncf properly reflect all revenues and expenditqres of funds provided
ii Palm Beach County agrees to assure that these records shall be subject at all reasonable time$ to inspection review or audit by state personnel and other personnel dlJly authorized by the Agency as well as by feder~I p~rsonnel
iii Pafm Beach County ~grees to comply with public record laws as outlined in section 1190701 Florjda Statutes
b RETENTION OF RECORDS
i The Palm Beach County agrees to retafn all financial records supporting dOCllrnents statistical records amiddotnd any other documents (including electronic storage media) pertinent to performance under this LOA for a period of six (6) years after termination of this LOA or if an audit has been initiated and audit findings have not been resolved at the end of six (6) years the records shall be retained until resolution of the audit fincUngs
ii Persons duly authorized by the Agency an_d federal auditors shall have full access to and the right to examine any of said records and documents
m The rights of access in this section must not be limited to the required retention period but shall last as long as the records are retained
c MONITORING
i Palm Beach County agrees to permit persons duly authorized by the Agency to im~pect any records papers1 and documents of the Palm Beach County which are relevant to this LOA
d ASSIGNMENT AND SUBCONTRACTS
L The Palm Beach County agrees to neither assign the responsibility of this LOA to another party nor subcontract for any of the work contemplated under this LOA without prior written approval of the Agency No such approval by the Agency of any assignment or subcontract shall be deemed in any event or in any manner to provide for the incurrence of any obligation of the Agency in addition to the total dollar amount agreed upon in this LOA All such assignments or subcontracts shall be subject to the conditions of this LOA and to any conditions of approval that the Agency shall deem neeessary
5 This LOA may only be amended upon written agreement signed by both parties The Palm Beach County and the Agency agree that cllY modific~tions to this LOA shall be in the same form namely the exchange of signed copies of a revised LOA
6 Palm Beach County confirms that there are no pre-arranged agreements (contractual or otherwise) between the respective counties taxing districts andor the providers to reshydirect any portion of these aforementioned supplemental payments in order to satisfy nonshyMedicaid non-uninsured and non-underinsured activities
Palm Beach County_Palm Beach County Fire Rescue_PEMT LOA_SFY 2019-20
7 Palm Beach County agrees the following provision shall be included In any agreements between Palm Beach County and focal providers where IGT funrHng is provided pursu~nl to this LOA Funding provld~d In this agreement shall be prlotitlzed so 1hat designated IGT funding_ shall first be used to fund the Medicaid program anci used seconclarlly for
middot other purposes
8 This LOA covers thEJ period of July 1 2019 through June 30 2020 and shall be terminated June 30 2020~
9 This LOA may be executed In mu1tlple counterparts each of which shall constitute ~n orlglnal and each of which shall be fully binding on a11y party ~lgnlng a1 least one colnlerpart
Minimum FeeScheduleMOO IGTs $70734128middot middotTotarFuntlln 28
IN WITNESS WHEREOF the patties have caused this page Letter of Agreement to be executed by their undersigned offlclals as duly authorized
Fire Rescue lstralor through TITLE erdenla G_e er Cpunly Ad1nlnlslrelot
DATE Decenibetmiddot 30 2019
APPROVED AS TO TlRMS AND CQNJr TIONS
Palm Beach County_Palm Beach County Fire Resoue_PEMT LOA_SFY 2019-20
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida Community Care LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Eric Tatum
Title Palm Beach County Fire Rescue Title Director of Provider Services Finance Director
Phone 561-616-7021 Phone786-778-6825
Email mmartz(pbcgovorg Email etatumfcchealthplancom
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
08272020
Nestor Plana CEO liltmllsiBil JiVITHO RIZED INDIVIDUAL
amp~ GNATURE OF A ORIZED INDIVIDUAL
5DF56FDF363949E
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORtND LE~ SUFFICIENCY
By LAl G - 1vv--Palm BeacCounty Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
electronic storage medi~) pertinent to performance under this LOA in accordance with generally accepted accounting procedures and practices which sufficiently ~ncf properly reflect all revenues and expenditqres of funds provided
ii Palm Beach County agrees to assure that these records shall be subject at all reasonable time$ to inspection review or audit by state personnel and other personnel dlJly authorized by the Agency as well as by feder~I p~rsonnel
iii Pafm Beach County ~grees to comply with public record laws as outlined in section 1190701 Florjda Statutes
b RETENTION OF RECORDS
i The Palm Beach County agrees to retafn all financial records supporting dOCllrnents statistical records amiddotnd any other documents (including electronic storage media) pertinent to performance under this LOA for a period of six (6) years after termination of this LOA or if an audit has been initiated and audit findings have not been resolved at the end of six (6) years the records shall be retained until resolution of the audit fincUngs
ii Persons duly authorized by the Agency an_d federal auditors shall have full access to and the right to examine any of said records and documents
m The rights of access in this section must not be limited to the required retention period but shall last as long as the records are retained
c MONITORING
i Palm Beach County agrees to permit persons duly authorized by the Agency to im~pect any records papers1 and documents of the Palm Beach County which are relevant to this LOA
d ASSIGNMENT AND SUBCONTRACTS
L The Palm Beach County agrees to neither assign the responsibility of this LOA to another party nor subcontract for any of the work contemplated under this LOA without prior written approval of the Agency No such approval by the Agency of any assignment or subcontract shall be deemed in any event or in any manner to provide for the incurrence of any obligation of the Agency in addition to the total dollar amount agreed upon in this LOA All such assignments or subcontracts shall be subject to the conditions of this LOA and to any conditions of approval that the Agency shall deem neeessary
5 This LOA may only be amended upon written agreement signed by both parties The Palm Beach County and the Agency agree that cllY modific~tions to this LOA shall be in the same form namely the exchange of signed copies of a revised LOA
6 Palm Beach County confirms that there are no pre-arranged agreements (contractual or otherwise) between the respective counties taxing districts andor the providers to reshydirect any portion of these aforementioned supplemental payments in order to satisfy nonshyMedicaid non-uninsured and non-underinsured activities
Palm Beach County_Palm Beach County Fire Rescue_PEMT LOA_SFY 2019-20
7 Palm Beach County agrees the following provision shall be included In any agreements between Palm Beach County and focal providers where IGT funrHng is provided pursu~nl to this LOA Funding provld~d In this agreement shall be prlotitlzed so 1hat designated IGT funding_ shall first be used to fund the Medicaid program anci used seconclarlly for
middot other purposes
8 This LOA covers thEJ period of July 1 2019 through June 30 2020 and shall be terminated June 30 2020~
9 This LOA may be executed In mu1tlple counterparts each of which shall constitute ~n orlglnal and each of which shall be fully binding on a11y party ~lgnlng a1 least one colnlerpart
Minimum FeeScheduleMOO IGTs $70734128middot middotTotarFuntlln 28
IN WITNESS WHEREOF the patties have caused this page Letter of Agreement to be executed by their undersigned offlclals as duly authorized
Fire Rescue lstralor through TITLE erdenla G_e er Cpunly Ad1nlnlslrelot
DATE Decenibetmiddot 30 2019
APPROVED AS TO TlRMS AND CQNJr TIONS
Palm Beach County_Palm Beach County Fire Resoue_PEMT LOA_SFY 2019-20
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida Community Care LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Eric Tatum
Title Palm Beach County Fire Rescue Title Director of Provider Services Finance Director
Phone 561-616-7021 Phone786-778-6825
Email mmartz(pbcgovorg Email etatumfcchealthplancom
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
08272020
Nestor Plana CEO liltmllsiBil JiVITHO RIZED INDIVIDUAL
amp~ GNATURE OF A ORIZED INDIVIDUAL
5DF56FDF363949E
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORtND LE~ SUFFICIENCY
By LAl G - 1vv--Palm BeacCounty Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
7 Palm Beach County agrees the following provision shall be included In any agreements between Palm Beach County and focal providers where IGT funrHng is provided pursu~nl to this LOA Funding provld~d In this agreement shall be prlotitlzed so 1hat designated IGT funding_ shall first be used to fund the Medicaid program anci used seconclarlly for
middot other purposes
8 This LOA covers thEJ period of July 1 2019 through June 30 2020 and shall be terminated June 30 2020~
9 This LOA may be executed In mu1tlple counterparts each of which shall constitute ~n orlglnal and each of which shall be fully binding on a11y party ~lgnlng a1 least one colnlerpart
Minimum FeeScheduleMOO IGTs $70734128middot middotTotarFuntlln 28
IN WITNESS WHEREOF the patties have caused this page Letter of Agreement to be executed by their undersigned offlclals as duly authorized
Fire Rescue lstralor through TITLE erdenla G_e er Cpunly Ad1nlnlslrelot
DATE Decenibetmiddot 30 2019
APPROVED AS TO TlRMS AND CQNJr TIONS
Palm Beach County_Palm Beach County Fire Resoue_PEMT LOA_SFY 2019-20
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida Community Care LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Eric Tatum
Title Palm Beach County Fire Rescue Title Director of Provider Services Finance Director
Phone 561-616-7021 Phone786-778-6825
Email mmartz(pbcgovorg Email etatumfcchealthplancom
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
08272020
Nestor Plana CEO liltmllsiBil JiVITHO RIZED INDIVIDUAL
amp~ GNATURE OF A ORIZED INDIVIDUAL
5DF56FDF363949E
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORtND LE~ SUFFICIENCY
By LAl G - 1vv--Palm BeacCounty Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida Community Care LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Eric Tatum
Title Palm Beach County Fire Rescue Title Director of Provider Services Finance Director
Phone 561-616-7021 Phone786-778-6825
Email mmartz(pbcgovorg Email etatumfcchealthplancom
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
08272020
Nestor Plana CEO liltmllsiBil JiVITHO RIZED INDIVIDUAL
amp~ GNATURE OF A ORIZED INDIVIDUAL
5DF56FDF363949E
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORtND LE~ SUFFICIENCY
By LAl G - 1vv--Palm BeacCounty Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
08272020
Nestor Plana CEO liltmllsiBil JiVITHO RIZED INDIVIDUAL
amp~ GNATURE OF A ORIZED INDIVIDUAL
5DF56FDF363949E
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORtND LE~ SUFFICIENCY
By LAl G - 1vv--Palm BeacCounty Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Miami Childrens Health Plan LLC (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Adriana Day
Title Palm Beach County Fire Rescue Title President Finance Director
Phone 561-616-7021 Phone786-624-5871
Email mmartzpbcgovorg Email Adrianadaymiamichildrenshealthplancom
LOA-Miami Childrens Health Planpdf 1 8202020 22928 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor
NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Adriana Dav President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
l~D IGNATUREO~
8172020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO
FORM ND LEGAL~ U UFFICIENCY
By ll~ ) VL~ Palm Beach County Attorney
8252020 95727 AM Miami Childrens Health Plan MCO-LOA 08-2020 signedpdf 2
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida Inc dba Staywell (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2 which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region _2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz
Title Palm Beach County Fire Rescue Finance Director
Phone 561-616-7021
Email mmartzpbcgovorg
LOA-WellCarepdf 1
Name Janette White
Title Sr Manager
Phone 813-532-7332
Email janettewhitewellcarecom
8202020 22935 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Elizabeth M Miller President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
82120 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~ I [V----Palm Beach County Attorney
LOA-WellCare Palm Beach (002)pdf 2 8252020 95418 AM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the _2 _ day of September 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan Inc a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable the Childrens Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Elizabeth M Miller
Title Palm Beach County Fire Rescue Title PresidentCEO Finance Director
Phone 561-616-7021 Sunshine State Health Plan Inc 1301 International Parkway 4th Floor
Email mmartzpbcgovorg Sunrise FL 33323
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Tamela Perdue Senior Vice President of Compliance NAME amp TITLE OF AUTHORIZED INDIVIDUAL
la111ela I fen(ue Tamela I Perdue (Sen 2 2020 1300 EDT)
SIGNATURE OF AUTHORIZED INDIVIDUAL
Sep 2 2020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By )1frac12 t 9 JL-___ Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the 3rd day of September 2020 by and between PALM BEACH COUNTY a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and SIMPLY HEALTHCARE PLANS INC DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region JL which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCO s Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCAs contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Barbara Morales
Title Palm Beach County Fire Rescue Title Provider Network Manager Finance Director
Phone 561-616-7021 Phone 954-405-6136
Email mmartzpbcgovorg Email bmoralessimplyhealthplanscom
Simolv Healthcare Plans Inc MCO 090320odf 1 9152020 25512 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Holly Jean Prince Interim CEO President amp Director NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By___ ____ __~___ _____ _ Palm Beach County Attorney
Simply Healthcare Plans Inc MCO 090320pdf 2 9152020 25512 PM
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Letter of Agreement
This Letter of Agreement (LOA) is made and entered into on the __ day of _____ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Florida True Health Inc dba Prestige Health Choice (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 2_ which includes Palm Beach County where Government Owned EMS Provider is located andor operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 2_ on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 4386 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCA s contractual requirements
3 Contact information for the parties is as follows
Name Michael Martz Name Shelly Turcu
Title Palm Beach County Fire Rescue Title Director Provider Network Finance Director
Phone 561-616-7021 Phone 561-839-2613
Email mmartzpbcgovorg Email sturcuprestigehealthchoicecom
LOA-Prestige Health Choicepdf 1 9152020 25826 PM
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
4 The Parties agree any modification to the LOA shall be in the same form namely the exchange of signed copies of a revised LOA
5 This LOA covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this LOA on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Kathy W amer President NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ____________ _ Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By ~b iir------Palm Beach County Attorney
LOA-Prestige Health Choicepdf 2 9152020 25826 PM
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
Public Emergency Medical Transportation Uniform Increase Agreement
This Public Emergency Medical Transportation Uniform Increase Agreement (PEMTUIA) is made and entered into on the __ day of ____ _ 2020 by and between Palm Beach County a political subdivision of the State of Florida (Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan Inc (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as Parties)
WHEREAS the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (ARCA) to deliver managed care services to Medicaid enrollees under an 1115 Managed Medical Assistance Waiver (the Waiver) in Region 9 which includes Palm Beach Martin St Lucie Indian River and Okeechobee County where Government Owned EMS Provider is located and or operates
WHEREAS ARCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 9 on an as needed basis when the transport and treatment is appropriate and
WHEREAS the Centers for Medicare and Medicaid Services (CMS) approved section 43 86 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed care organizations pursuant to the Waiver which includes the Medicaid MCO
NOW THEREFORE Government Owned EMS Provider and the Medicaid MCO do hereby agree to the following
1 Government Owned EMS Provider agrees to make emergency medical services available to MCOs Medicaid enrollees on an as needed basis when the transport and treatment is appropriate
2 Medicaid MCO shall receive per member per month section 4386 directed payments for care and treatment provided by the Government Owned EMS Provider which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with ARCAs contractual requirements
3 Contact information for the parties is as follows
Name Mike Martz Name Betsy Dennis
Title Finance Director Title Manager Provider Contracting
Phone 561-616-7021 Phone 727 453 8131
Email mmartzpbcgovorg Email EDennis6humanacom
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney
4 The Parties agree any modification to the Public Emergency Medical Transportation Uniform
increase agreement shall be in the same form namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement
5 This Public Emergency Medical Transportation Uniform Increase Agreement covers the period of October 1 2019 through June 30 2024 unless terminated sooner by the termination of section 4386 directed payments
IN WITNESS WHEREOF the Parties have duly executed this Public Emergency Medical Transportation Uniform Increase Agreement on the day and year above first written Each party represents that (i) it has the authority to enter into this Agreement and (ii) that the individual signing this Agreement on its behalf is authorized to do so
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER PALM BEACH COUNTY FLORIDA BY ITS BOARD OF COUNTY COMMISSIONERS
Dave Kerner Mayor NAME amp TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
Lori Dunne Regional VP Operations NAME amp TITLE OF AUTHORIZED INDIVIDUAL
dJJU 0run1J SIGNATURE OF AUTHORIZED INDIVIDUAL
8132020 DATE
ATTEST SHARON R BOCK Palm Beach County Clerk amp Comptroller
By ___________ _
Deputy Clerk
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
By filn sect lJ1----Palm Beach County Attorney